Healthcare Provider Details

I. General information

NPI: 1134343866
Provider Name (Legal Business Name): CENTER FOR FACIAL PLASTIC SURGERY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 WEST OLD NORTHWEST HIGHWAY
BARRINGTON IL
60010-6828
US

IV. Provider business mailing address

515 W OLD NORTHWEST HWY
BARRINGTON IL
60010-6828
US

V. Phone/Fax

Practice location:
  • Phone: 847-304-1000
  • Fax: 847-304-1182
Mailing address:
  • Phone: 847-304-1000
  • Fax: 847-304-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberNOT NEEDED
License Number StateIL

VIII. Authorized Official

Name: DR. GARY S. CHURCHILL
Title or Position: OWNER
Credential: M.D.
Phone: 847-304-1000